Surgical instrument guide with insufflation channels

ABSTRACT

A cannula and instrument guide assembly includes a cannula with a proximal portion and a tube. An instrument guide is removably inserted into the proximal portion of the cannula and extends through the cannula to a distal end of the tube. The proximal portion of the cannula has an insufflation port. The instrument guide provides at least one interior passageway to support a shaft of a surgical instrument that passes through the instrument guide. One or more channels on an outer surface of the instrument guide provide a passage for insufflation gas received from the insufflation port to the distal end of the tube. The one or more channels have a first cross-sectional area at a proximal end and a second, larger cross-sectional area at a distal end. The one or more channels may have the first cross-sectional area along a majority of the length of the channels.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a National Stage Filing under 35 U.S.C. 371 fromInternational Application No. PCT/US2017/041787, filed on 12 Jul. 2017,and published as WO 2018/013734 A1 on 18 Jan. 2018,which claims thebenefit pursuant to 35 U.S.C. 119(e) of U.S. Provisional Application No.62/361,931, filed 13 Jul. 2016, each of which application isspecifically incorporated herein, in its entirety, by reference.

BACKGROUND

Field

Embodiments of the invention relate to the field of endoscopic surgicalinstruments and, in particular, to instrument guides for endoscopicsurgical instruments that include channels for introducing insufflationgases.

Background

Minimally invasive medical techniques have been used to reduce theamount of extraneous tissue which may be damaged during diagnostic orsurgical procedures, thereby reducing patient recovery time, discomfort,and deleterious side effects. Traditional forms of minimally invasivesurgery include endoscopy. One of the more common forms of endoscopy islaparoscopy, which is minimally invasive inspection or surgery withinthe abdominal cavity. In traditional laparoscopic surgery, a patient'sabdominal cavity is insufflated with gas, and cannula sleeves are passedthrough small (approximately 12 mm) incisions in the musculature of thepatient's abdomen to provide entry ports through which laparoscopicsurgical instruments can be passed in a sealed fashion.

The laparoscopic surgical instruments generally include a laparoscopefor viewing the surgical field and surgical instruments having endeffectors. Typical surgical tools include clamps, graspers, scissors,staplers, and needle holders, for example. The surgical instruments aresimilar to those used in conventional (open) surgery, except that theend effector of each surgical instrument is separated from its handle byan approximately 30 cm. long extension tube, for example, so as topermit the operator to introduce the end effector to the surgical siteand to control movement of the end effector relative to the surgicalsite from outside a patient's body.

To reduce the trauma of minimally invasive surgery even further,techniques are being developed to allow minimally invasive surgery usingonly a single access port into the body, such as a single incision orsingle natural body orifice. This access may be accomplished by using asomewhat larger cannula that can accommodate all of the instrumentsrequired for the surgery. Minimally invasive surgery performed through asingle incision or natural orifice may be referred to as single portaccess (SPA) surgery. The single cannula that provides the single portmay be introduced through a body orifice or through an incision.

If multiple surgical instruments and/or camera instruments areintroduced to a surgical site through a single cannula, it is desirableto use as small a cannula as possible, consistent with the size of theinstruments to be passed through the cannula. Passages also must beprovided to supply insufflation gas to inflate the surgical site and tocontinually replace gas lost to leakage. The passages also may alsoallow the surgical site to be evacuated.

Therefore, there is a need for better and more effective devices forintroducing surgical instruments and supplying insufflation gas to asurgical site through a small incision.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may best be understood by referring to the followingdescription and accompanying drawings that are used to illustrateembodiments of the invention by way of example and not limitation. Inthe drawings, in which like reference numerals indicate similarelements:

FIG. 1 is a view of an illustrative teleoperated surgical system.

FIG. 2 is a pictorial view of an unassembled access port.

FIG. 3 is a side view of assembled access port with a portion of thecannula cut away to show the instrument guide that is inserted into thecannula.

FIG. 4 is a cross-section of the instrument guide taken along line 4-4in FIG. 3.

FIG. 5A is a cross-section of the instrument guide taken along line 5-5in FIG. 3.

FIG. 5B is an enlarged cross-section of the instrument guide taken alongline 5-5 in FIG. 3.

FIG. 6 is a schematic side view of the instrument guide inserted intothe cannula to illustrate the flow of insufflation gas.

DESCRIPTION OF EMBODIMENTS

In the following description, numerous specific details are set forth.However, it is understood that embodiments of the invention may bepracticed without these specific details. In other instances, well-knowncircuits, structures, and techniques have not been shown in detail inorder not to obscure the understanding of this description.

In the following description, reference is made to the accompanyingdrawings, which illustrate several embodiments of the present invention.It is understood that other embodiments may be utilized, and mechanicalcompositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of the presentdisclosure. The following detailed description is not to be taken in alimiting sense, and the scope of the embodiments of the presentinvention is defined only by the claims of the issued patent.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.Spatially relative terms, such as “beneath”, “below”, “lower”, “above”,“upper”, and the like may be used herein for ease of description todescribe one element's or feature's relationship to another element(s)or feature(s) as illustrated in the figures. It will be understood thatthe spatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if the device in thefigures is turned over, elements described as “below” or “beneath” otherelements or features would then be oriented “above” the other elementsor features. Thus, the exemplary term “below” can encompass both anorientation of above and below. The device may be otherwise oriented(e.g., rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly.

As used herein, the singular forms “a,” “an,” and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising” specify the presence of stated features, steps,operations, elements, and/or components, but do not preclude thepresence or addition of one or more other features, steps, operations,elements, components, and/or groups thereof.

The term “object” generally refers to a component or group ofcomponents. For example, an object may refer to either a pocket or aboss of a disk within the specification or claims. Throughout thespecification and claims, the terms “object,” “component,” “portion,”“part” and “piece” are used interchangeably.

The terms “or” and “and/or” as used herein are to be interpreted asinclusive or meaning any one or any combination. Therefore, “A, B, or C”or “A, B, and/or C” mean “any of the following: A; B; C; A and B; A andC; B and C; A, B, and C.” An exception to this definition will occuronly when a combination of elements, functions, steps, or acts are insome way inherently mutually exclusive.

Terms of approximation, such as “substantially” and “about,” as usedherein are to be interpreted as meaning equal to a stated amount withina tolerance that is appropriate to the manufacturing processes thatproduces the stated amount or to the use or requirement for the statedamount. Thus a length that is substantially a stated amount could be thestated amount plus or minus a small amount if the length is produced bya precise process or represents a critical dimension. Conversely, alength that is substantially a stated amount could be the stated amountplus or minus a large amount if the length is produced by an impreciseprocess or represents a non-critical dimension.

The terms “instrument” and “surgical instrument” are used herein todescribe a medical device configured to be inserted into a patient'sbody and used to carry out surgical or diagnostic procedures. Thesurgical instrument typically includes an end effector associated withone or more surgical tasks, such as a forceps, a needle driver, ashears, a bipolar cauterizer, a tissue stabilizer or retractor, a clipapplier, an anastomosis device, an imaging device (e.g., an endoscope orultrasound probe), and the like. Some instruments used with embodimentsof the invention further provide an articulated support (sometimesreferred to as a “wrist”) for the surgical tool so that the position andorientation of the surgical tool can be manipulated with one or moremechanical degrees of freedom in relation to the instrument's shaft.Further, many surgical end effectors include a functional mechanicaldegree of freedom, such as jaws that open or close, or a knife thattranslates along a path. Surgical instruments may also contain stored(e.g., on a semiconductor memory inside the instrument) information thatmay be permanent or may be updatable by the surgical system.Accordingly, the system may provide for either one-way or two-wayinformation communication between the instrument and one or more systemcomponents.

FIG. 1 shows a pictorial view of a minimally invasive teleoperatedsurgical procedure on a patient 110 using a single access port 100 forteleoperated surgical instruments 102, 104, 106. The single access port100 is inserted through a single incision 112. Typically three or foursurgical instruments (instruments 102, 104, and 106 are illustrated),including a camera instrument, are introduced through the single accessport 100. In addition, there will generally be provisions forintroducing an insufflation gas, such as carbon dioxide (CO₂), at ornear the single access port 100. It will be appreciated that single portsurgery uses a substantial amount of equipment located in a small amountof space.

The teleoperated surgical instruments 102, 104, and 106, which mayinclude a camera instrument that may provide images of the surgical siteand other instruments at the surgical site, are each coupled to acorresponding actuator, such as one of actuators 122, 124, 126, and 128.The actuators 122, 124, 126, and 128 are servo actuators that allow asurgeon to manipulate the surgical instruments using a computer-mediatedcontrol station 120. These manipulations may include functions such aschanging the position and orientation of the surgical instrument's endeffector (to include a camera) and operating the end effector (such asclosing jaws to effect grasping, cutting, etc.). Such actuator controlof surgical instruments may be referred to by various terms, such asteleoperated surgery. The actuators 122, 124, 126, and 128 may besupported on a separate structural arm that, once positioned, can befixed relative to the patient 110. In various implementations thesupporting arm may be manually positioned, may be positioned by thesurgeon, or may be automatically positioned by the system as the surgeonmoves one or more of the surgical instruments.

A control system couples a computer-mediated control station 120 to theteleoperated actuators 122, 124, 126, and 128. Here “computer” broadlyencompasses a data processing unit that incorporates a memory and anadditive or logical function, such as an arithmetic logic unit, that isprogrammable to perform arithmetic or logical operations. The controlsystem may coordinate movement of the input devices with the movement oftheir associated surgical instruments so that the images of the surgicalinstruments 102, 104, 106, as displayed to the surgeon, appear at leastsubstantially connected to the input devices in the hands of thesurgeon. Further levels of connection will also often be provided toenhance the surgeon's dexterity and ease of use of the surgicalinstruments 102, 104, and 106.

The computer-mediated control station 120 may provide hand operatedmaster controllers 130 that allow manipulation of the teleoperatedsurgical instruments 102, 104, 106 by transmitting signals, such aselectrical or optical control signals provided by cables 132, to theactuators 122, 124, 126, and 128 that control the actions of the coupledsurgical instruments 102, 104, and 106. Typically one of the surgicalinstruments, surgical instrument 102 for example, will be a camerainstrument that is manipulated to place the remaining surgicalinstruments and the objects being manipulated within a field of view ofthe camera. The camera instrument transmits signals to the controlstation 120 so that an image captured by the camera of the instrumentsand objects within the field of view can be displayed on a visualdisplay 134 that is viewed by the surgeon as the coupled surgicalinstruments 104, 106 are manipulated. The hand-operated controllers 130and the visual display 134 may be arranged to provide an intuitivecontrol of the surgical instruments 104, 106, in which the instrumentsmove in a manner similar to the operator's hand movements with thecontrollers.

FIG. 2 is a pictorial view of an unassembled cannula and instrumentguide assembly that forms an access port 100 which can be insertedthrough the incision 112. The access port 100 is shown before the partsare assembled into the configuration used during a surgical procedure.When assembled, the cannula and instrument guide assembly provides thesingle port access shown in FIG. 1.

The access port 100 includes a cannula 200 having a lumen or tube 202that is inserted through the incision 112 to separate and protect theincision. The access port 100 further includes an instrument guide 220that is inserted into the cannula 200. The instrument guide 220 may becoupled to the cannula 200 in various ways to retain the instrumentguide in the cannula during the surgical procedure. The instrument guide220 guides one or more instruments through the cannula 200 to facilitateinstrument access to the surgical site.

The cannula 200 includes a proximal portion 204 having an insufflationport 206 and a tube 202 coupled to the proximal portion. Theinsufflation port 206 receives an insufflation gas, such as carbondioxide (CO₂), that is introduced to the surgical site through the tube202 portion of the cannula 200.

The access port 100 may include a seal assembly 210 that is coupled tothe cannula 200. The seal assembly 210 seals the access port 100 toreduce loss of insufflation gas when the instrument guide 220 is notinserted into the cannula 200.

The instrument guide 220 may be joined to a funnel assembly 230 thatprovides instrument receivers 232 to guide instruments into passages inthe instrument guide at the proximal end of the instrument guide. Thefunnel assembly 230 may include seals that seal the instrument passagesin the instrument guide 220 to reduce loss of insufflation gas when aninstrument is not inserted into an instrument passage. The instrumentguide 220 may include one or more instrument passages. Instrument guidesmay include one, two, three, four, five, six, or more instrumentpassages. The instrument passages may all be the same size and shape orthey may vary in size and/or shape. Each instrument passage may have acircular cross-section or an oval cross-section or other cross-sectionshape that corresponds to the shape of the instrument shaft to besupported by the instrument passage.

The distal portion of the instrument guide 220 is configured to fitclosely within the tube 202 portion of the cannula 200. Each of the oneor more instrument passages in the instrument guide 220 is configured tosupport a single surgical instrument at a defined position within thecannula 200. The surgical instruments are inserted into the access port100 through the instrument receivers 232 in the funnel assembly 230 sothat they are directed into the instrument passages at a proximal end ofthe instrument guide 220. The surgical instruments are supported by theinstrument passages until they emerge from a distal end of theinstrument guide 220. In some embodiments, the instrument guide 220 maybe formed from an electrically non-conductive material to aid inelectrically isolating the instruments, which may carry an electricalcharge used for electrosurgical applications (e.g., cauterization). Inother embodiments, the instrument guide 220 may be formed from aconductive material, such as metal or conductive plastic, to aid indissipating any electrical charge that might build up on the instrumentspassing through the guide.

In some embodiments, the cannula 200 may be reusable (e.g., aftercleaning and sterilization). Some or all of the instrument guide 220,the funnel assembly 230, and the seal assembly 210 may be provided as asterile, disposable kit, e.g., a gamma sterilized kit, so that a newinstrument guide, a new funnel assembly, and/or a new seal assembly maybe used for each surgical procedure.

FIG. 3 shows a side view of the access port 100 with the cannula 200 cutaway along a diameter to show the instrument guide 220 inserted into thecannula. The instrument guide 220 includes at least one channel 224 onan outer surface 222 of an outer wall of the instrument guide to form apassage for insufflation gas from the insufflation port 206 to thedistal end of the tube 202 portion of the cannula 200.

The channel 224 is adjacent an interior surface of the tube 202 to formthe passage for insufflation gas when the instrument guide 220 isinserted into the tube. The channel 224 extends completely to the distalend 300 of the instrument guide 220. The channel 224 extends toward butdoes not reach the proximal end of the instrument guide 220. The channel224 extends toward the proximal end sufficiently for the proximal end302 of the channel to receive insufflation gas that flows from theinsufflation port 206 and through the proximal portion 204 of thecannula 200.

The seal assembly 210 may include a proximal seal 306 and sealing flaps304. The proximal seal 306 seals the instrument guide 220 beyond theproximal end 302 of the channels 224 to prevent insufflation gas fromescaping past the instrument guide at the proximal end of the cannula200. The sealing flaps 304 are opened when the instrument guide 220 isinserted into the tube 202. While the sealing flaps 304 appear to blockthe flow of insufflation gas from the insufflation port 206 to theproximal end 302 of the channels, there are openings between the flapsthat allow the flow of insufflation gas throughout the proximal portion204 of the cannula 200. Thus the cannula and instrument guide assemblyof the access port 100 provides a mechanism for introducing insufflationgas into the surgical sites while minimizing the loss of insufflationgas from the assembly.

FIG. 4 is a cross-section of the instrument guide 220 taken alongsection line 4-4. FIGS. 5A and 5B are cross-sections of the instrumentguide 220 taken along section line 5-5. FIG. 5A omits the detail of thechannel end view that is shown in the enlarged view of FIG. 5B.

It is necessary to provide a flow rate of insufflation gas sufficient toinflate the surgical region to a set pressure, perhaps 8 to 14 mm Hg,and replace gas loss due to leakage. Insufflation gas may be supplied ata pressure of about 15 mm Hg (about 2,000 Pa). The flow rate may beabout 20 l/min. It will be appreciated that the velocity of insufflationgas flowing through the one or more channels 224 depends on thecross-sectional area of the channel. The flow will have a highervelocity when the cross-sectional area is small and a lower velocitywhen the cross-sectional area is large. But it is desirable to have asmall cross-sectional area for the one or more channels 224 to minimizethe diameter of the instrument guide 220 and the cannula's tube 202. Thecross-sectional area for the one or more channels 224 is constrained bythe need to maintain a certain wall thickness for the structuralintegrity and manufacturability of the instrument guide 220.

It is also desirable to avoid high velocity flow of insufflation gasthat can disturb or even damage tissues adjacent the distal end of thecannula 200 where the insufflation gas is discharged into the surgicalsite. To provide a small diameter instrument guide 220 while minimizingthe discharge velocity of insufflation gas, the one or more channels 224having a first cross-sectional area at a proximal end of the channel anda second cross-sectional area at a distal end of the channel that islarger than the first cross-sectional area.

The one or more channels 224 have the first cross-sectional area for themajority of the length of the channel. A transitional section 308 beginsclose to the distal end of the channel 224 to provide a transition tothe second cross-sectional area. The transition is made just long enoughto avoid introducing turbulence in the flow of the insufflation gas. Insome embodiments, the transition from the first cross-sectional area tothe second cross-sectional area is about 1 inch (25 mm) long. Bylimiting the larger cross-sectional areas to the distal end 300 of theinstrument guide 220, the adverse consequences of the largercross-sectional areas are minimized. This allows the instrument guide220 to have a smaller diameter than would be possible if the channel 224had the second cross-sectional area for its entire length. In someembodiments, the second cross-sectional area is at least twice the firstcross-sectional area, reducing the discharge velocity of theinsufflation gas to half or less than the velocity at the proximal endof the channel. For example, in one embodiment the first cross-sectionalarea is about 0.0023 in² (1.5 mm²) and the second cross-sectional areais about 0.0050 in² (3.0 mm²).

The one or more channels 224 are located relative to the interiorpassageways to provide a first wall thickness for the instrument guidewhere the channel has the first cross-sectional area and a second wallthickness for the instrument guide where the at least one channel hasthe second cross-sectional area, the second wall thickness being lessthan the first wall thickness.

FIG. 6 shows a schematic side view of the instrument guide 220 insertedinto the cannula 200 to illustrate the flow of insufflation gas from theinsufflation port 206 to the surgical site 602. The double dashed arrowssuggest the flow of insufflation gas 600. The cannula 200 is insertedthrough an incision 112 which seals against the outside of the cannula.The proximal portion 204 of the cannula 200 forms a plenum that suppliesinsufflation gas. The proximal portion 204 is sealed at the proximal endby the proximal seal 306 sealing against the instrument guide 220.

Insufflation gas enters the one or more channels 224 on the outersurface 222 of the instrument guide 220 from the plenum formed by theproximal portion 204 of the cannula 200 and flows toward the distal end300 of the instrument guide. The one or more channels 224 include atransition section 308 that has an increasing cross-sectional area atthe distal end 300 of the channels. As suggested by the reduced lengthof the double dashed arrow in the transition section 308, the increasingcross-sectional area of the transition section reduces the velocity ofthe insufflation gas before it is discharged into the surgical site 602.

While certain exemplary embodiments have been described and shown in theaccompanying drawings, it is to be understood that such embodiments aremerely illustrative of and not restrictive on the broad invention, andthat this invention is not limited to the specific constructions andarrangements shown and described, since various other modifications mayoccur to those of ordinary skill in the art. For example, while the useof the channels of the instrument guide have been described for thedelivery of insufflation gas to the surgical site, the same or similarchannels can be used to evacuate gases and/or smoke from the surgicalsite. The description is thus to be regarded as illustrative instead oflimiting.

What is claimed is:
 1. A medical device comprising: an instrument guidehaving an outer wall, a distal end, an interior passageway, and aninsufflation gas channel; the outer wall extending to the distal end ofthe instrument guide; the interior passageway being shaped to support ashaft of a surgical instrument inserted through the interior passageway;and the insufflation gas channel being defined in an outer surface ofthe outer wall and extending to the distal end of the instrument guide,the insufflation gas channel having a first cross-sectional area at aposition at which insufflation gas is introduced into the insufflationgas channel and a second cross-sectional area at the distal end of theinstrument guide, the second cross-sectional area being larger than thefirst cross-sectional area.
 2. The medical device of claim 1, whereinthe insufflation gas channel has the first cross-sectional area along amajority of a length of the insufflation gas channel.
 3. The medicaldevice of claim 1, wherein the insufflation gas channel is locatedrelative to the interior passageway to provide a first wall thicknessfor the outer wall of the instrument guide where the insufflation gaschannel has the first cross-sectional area and a second wall thicknessfor the outer wall of the instrument guide where the insufflation gaschannel has the second cross-sectional area, the second wall thicknessbeing less than the first wall thickness.
 4. The medical device of claim1, wherein the insufflation gas channel extends toward, but does notreach, a proximal end of the instrument guide.
 5. The medical device ofclaim 1, wherein the second cross-sectional area of the insufflation gaschannel is at least twice the first cross-sectional area.
 6. The medicaldevice of claim 1, further comprising: a cannula including a proximalportion, an insufflation port at the proximal portion of the cannula,and a tube coupled to the proximal portion of the cannula; wherein theinstrument guide is removably inserted into the proximal portion of thecannula and extends through the cannula to a distal end of the tube. 7.The medical device of claim 6, wherein the insufflation gas channel isadjacent an interior surface of the tube of the cannula to form apassage for insufflation gas.
 8. The medical device of claim 1, whereinthe instrument guide further comprises a funnel assembly coupled to aproximal portion of the instrument guide to reduce insufflation gasleakage from the proximal portion of the instrument guide and to guideinsertion of the shaft of the surgical instrument into and through theinterior passageway of the instrument guide.
 9. The medical device ofclaim 1, wherein the instrument guide further comprises a plurality ofinterior passageways.
 10. The medical device of claim 9, wherein theinstrument guide further comprises a plurality of radial walls, each ofthe plurality of radial walls being between two of the plurality ofinterior passageways.
 11. The medical device of claim 10, wherein theinstrument guide further comprises a plurality of insufflation gaschannels, each of the plurality of insufflation gas channels is furtherdefined in the outer surface of the outer wall opposite a location whereone of the plurality of radial walls joins the outer wall.
 12. A methodof providing insufflation gas to a surgical site, the method comprising:inserting a cannula through an incision, the cannula including aproximal portion having an insufflation port, and a tube coupled to theproximal portion; inserting an instrument guide into the proximalportion of the cannula and through the cannula to a distal end of thetube, the instrument guide providing an interior passageway to support ashaft of a surgical instrument, and an insufflation gas channel on anouter surface of the instrument guide to form a passage for insufflationgas from the insufflation port to the distal end of the tube, theinsufflation gas channel having a first cross-sectional area at aproximal end of the insufflation gas channel and a secondcross-sectional area at a distal end of the insufflation gas channelbeing larger than the first cross- sectional area; and supplyinginsufflation gas to the insufflation port.
 13. The method of providinginsufflation gas of claim 12, wherein the insufflation gas channel isadjacent an interior surface of the tube to form the passage forinsufflation gas.
 14. The method of providing insufflation gas of claim12, wherein the insufflation gas channel extends toward, but does notreach, a proximal end of the instrument guide.
 15. The method ofproviding insufflation gas of claim 12, wherein the insufflation gaschannel has the first cross-sectional area along a majority of a lengthof the insufflation gas channel.
 16. The method of providinginsufflation gas of claim 12, wherein the second cross-sectional area isat least twice the first cross-sectional area.
 17. The method ofproviding insufflation gas of claim 12, further comprising coupling afunnel assembly to the proximal portion of the cannula to reduceinsufflation gas leakage from the proximal portion of the cannula and toguide insertion of the shaft of the surgical instrument into and throughthe interior passageway of the instrument guide.
 18. The method ofproviding insufflation gas of claim 12, wherein the insufflation gaschannel is located relative to the interior passageway to provide afirst wall thickness for the instrument guide where the insufflation gaschannel has the first cross-sectional area and a second wall thicknessfor the instrument guide where the insufflation gas channel has thesecond cross-sectional area, the second wall thickness being less thanthe first wall thickness.